advanced search

<< Back To Home

WHAT'S NEW THIS THURSDAY: MARK DYBUL TO PILOT GLOBAL FUND THROUGH FINANCIAL CRISIS

Wednesday, 16th of January 2013

 

• MARK DYBUL TO PILOT GLOBAL FUND THROUGH FINANCIAL CRISIS

The Lancet Infectious Diseases, Volume 13, Issue 1, Pages 19 - 20, January 2013

David Holmes

At the end of a turbulent year at the Global Fund, Mark Dybul, the former US Global AIDS Coordinator, has been elected Executive Director. David Holmes reports.

It was a 10th anniversary to remember, but not for all the right reasons. In 2012 the Global Fund to Fight AIDS, Tuberculosis and Malaria looked back on a decade during which it helped bring the world to a tipping point in the fight against the three diseases by funding prevention and treatment initiatives to the tune of over US$20 billion. But at the same time, it looked forward to an uncertain future. Shorn of operational leadership after Executive Director Michel Kazatchine bowed to the inevitable and fell on his sword in January, after a perfect storm of funding shortfalls and corruption scandals sapped the confidence of the fund's donors, the organisation turned inward as the opaque process of appointing a successor unfolded. In November, that process finally drew to a close with the announcement of Mark Dybul as the new Executive Director of the organisation.

Dybul will start early in 2013, and is relishing taking the reins at a time when, by his own admission, “maximising the opportunities within the challenges is not going to be easy”. One of his first challenges will be to help to heal some of the self-inflicted wounds sustained by the fund's board during the months of political infighting that preceded his appointment.

The intrigue began with the board's decision in January to shut Kazatchine out by parachuting in the Columbian-born banker Gabriel Jaramillo to take charge of the day-to-day running of the Fund, despite vehement protests from the French Government, with whom Kazatchine had strong ties. “What I understand is that was very much viewed as the US hand at play”, James Sherry, Director of the Center for Global Health at the George Washington University, told TLID. “If that is the view, that it was a US-inspired change, and then the person who replaces Kazatchine is an American, I don't know how that plays out”, Sherry muses.

It is important to note, however, that Dybul was elected rather than anointed. In the first-round ballot, the 20 voting members of the board, which is composed of the representatives of donors, non-governmental organisations, and recipients, whittled a shortlist of four candidates down to two. The gender-balanced shortlist, one of the worst-kept secrets in a process that was otherwise notable for its lack of transparency, was made up of candidates taken entirely from donor countries: Canada's Robert Greenhill, Monique Barbut of France, Barbara Stocking from the UK, and Dybul. It was Dybul and Greenhill who made the cut, with Dybul eventually winning through in the final round with the backing of all but two voting members, both of whom abstained—one of whom was France according to the Financial Times.

In the same article the Financial Times quoted Simon Bland, the British chairman of the Fund's board, as maintaining that the process “was pretty passport-blind, not about nations fighting for candidates. It came down to the individuals.” But the fact the election went the way it did, notes Sherry, could be a cause of friction. “It would be interesting to take the measure of what peoples' view on this was”, he says. “Was it a capitulation to the US, or was it a recognition of Mark's rather unusual leadership capacity?”

What is less in doubt is that, if the job had to go to an American, Dybul is the right American for the job. In particular, his pivotal role in the conception and, eventually, his leadership of the US President's Emergency Plan for AIDS Relief (PEPFAR) give him the “experience and skill-set that are important for the Fund and for the world right now”, according to Joanne Carter, Executive Director of the RESULTS antipoverty advocacy organisation. And bearing in mind the potentially lukewarm welcome he might expect from some quarters, he is something of a past master at soothing bruised egos and “bringing people together to work for the common good”, says Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases in Bethesda, MD, USA, and Dybul's former boss.

 

Full-size image (49K) The Global Fund 

 

Full-size image (85K) Ma Yixing/ColorChinaPhoto/AP/Press Association Images 

Emerging economies, such as China, will have important roles as programme partners rather than aid recipients

Dybul is also, says Fauci, a visionary, whose days at PEPFAR mean he already has strong relationships with leaders in public health, in national political leadership, and in civil society in a wide array of implementing countries and donors. The acid test will come in September, 2013, the date set for 2014—16 replenishment meeting, when it will become clear whether or not the vision laid out by Dybul and his team has tempted donors to loosen their purse strings. Dybul is certainly confident. “I know from my work with PEPFAR that there is money available, but people want it spent well. And because of the changes the Fund has made it can make the case that it is pursuing high impact and high value”, he told TLID.

Central to making that case, according to Elly Katabira, the immediate past president of the International Aids Society, will be the fund's ability to show it is able to “prioritise the countries and programmes that can deliver. Because the contributors, Europe, and North America, will be looking for value for money.” For example, he says, “I don't think that the Global Fund should be giving money to China; actually China should be giving money to the Global Fund”.

At 11 years old, the fund finds itself in a world very different from that in which it was conceived. The poles of economic power have shifted to Asia and Latin America, with Europe embroiled in a seemingly endless debt crisis, and this presents particular challenges for a multilateral organisation like the Global Fund. New powers like China and Brazil have made it clear that they're not interested in contributing directly to the Fund, but, says Dybul, “you can partner with them to work in regional and subregional ways to work on the things they want to work on. They're also interested in their own backyard in Latin America and Asia, so you can triple down with regional development banks”. And Dybul is keen to emphasise that the Global Fund is primed to innovate in its bid to deliver on the impact and value mantra. “We can work with other development institutions and finance institutions, we can work with the World Bank and regional development banks to cofinance national programmes. We can look at innovative finance tools like social impact bonds. And we can look at advance market commitments to forward fund the commodities that are needed for HIV, TB, and malaria in the way that GAVI did for vaccines”, he says.

A changed world, however, does not only present challenges. “The new scientific data that emerged last year and the latest modelling, coupled with the impact we've already achieved through aggressive scale-up against HIV, tuberculosis, and malaria show that we can see our way to the end of these diseases”, says RESULT's Carter. “Not to minimise the challenges or the long road ahead, but this is a pivotal moment. Specifically with regards to the Global Fund, we have the opportunity for the Global Fund to evolve its role from a leading mechanism for fighting the diseases to a lead role in ending them.” And that, says Dybul, is a pretty attractive proposition to policy makers with limited time horizons. “If you can control three diseases within the terms of many policy makers then that's a pretty appealing thing for them”, he notes. “It's not 50 years from now, we can actually do this today.”

Regardless of how the fund and its partners go about trying to achieve that ambition, there will be criticism; something Dybul is familiar with from his time at PEPFAR. The programme's emphasis on abstinence and sexual fidelity as the primary ways to control the HIV epidemic in sub-Saharan Africa drew vocal opposition from the US activist community, but criticism of Dybul was wide of the mark, according to Sherry. “I think for Mark, he worked to be comfortable with the broad scope of PEPFAR, which many of us did. Many of us were more comfortable with some aspects than others, but then you measure it all out and say ‘advancing this line at this time within these political constraints is still going to serve our purpose'”, he says. “The notion that Mark was some kind of an ideological step child of the Bush administration is just incorrect.”

For a list of Global Fund Board members see http://www.theglobalfund.org/en/board/members/

For the Financial Times article on Dybul's appointment see http://www.ft.com/cms/s/0/2353944c-2f4f-11e2-b88b-00144feabdc0.html#axzz2E5iD2Xqe